Cardiology Flashcards
Causes of Peripheral Cyanosis
- Peripheral vascular disease
- Raynaud’s syndrome
- Heart failure
- Shock
- Central cyanosis (when severe)
Causes of irregular irregular pulse
- AF
- Ventricular ectopic beats (VEB)
Differentiate between 1 and 2 by exercising patient (VEB will be abolished)
Causes of AF
- Ischaemic heart disease
- Rheumatic heart disease
- Thyrotoxicosis
- Pneumonia / PE / Alcohol
Causes of an absent radial pulse
- Congenital (usually bilateral)
- Previous arterial line
- Previous cardiac catheterisation
- Atheromatous disease (usually subclavian)
- Arterial embolism (e.g. AF)
- Surgical ligation
Increased JVP
- RHF
- Volume overload
- PE
- SVC obstruction (raised and fixed)
Large a-wave
- Pulmonary HTN
2. Pulmonary stenosis
Giant v-wave
- Tricuspid regurgitation
Causes of non-palpable apex beat
- Adipose tissue (obese patient)
- Air (pneumothorax, COPD)
- Fluid (pleural effusion, haemothorax, pericardial effusion)
- Apex displaced (usually LVH)
- Dextrocardia
Causes of LVH
- Aortic stenosis
- Hypertension
- HOCM
- Coarctation of the aorta
Causes of third heart sound
(Volume overload) Normal if <30 years old 1. CHF/MI/cardiomyopathy 2. HTN 3. MR
Causes of fourth heart sound
(Stiffening of ventricle walls) - always abnormal, cannot be Dx in the context of AF
- CHF/MI/cardiomyopathy
- HTN
Causes of cardiac failure
- Pump failure
- Excessive preload
- Excessive after load
- Isolated RHF
Cardiac failure - pump failure Ddx
- IHD
- Cardiomyopathy
- Constrictive pericarditis
- Arrhythmias
- Negative ino/chronotropes
Cardiac failure - excessive preload Ddx
- AR/MR
2. Fluid excess (renal failure, Iv fluids)
Cardiac failure - excessive after load Ddx
- AS
2. HTN
Cardiac Failure - isolated RHF
- Cor pulmonale
2. Pulmonary HTN
CXR features of LVF
ABCDE
- Alveolar oedema
- Kerley B lines
- Cardiomegaly
- Upper lobe venous diversion
- Pleural effusion
Causes of pericarditis
- Viral (coxsackie)
- Bacterial / fungal infection
- Immediately post-MI
- Dressler’s syndrome
- SLE / RA / Scleroderma
- Uraemia
- Malignancy
Indication for pacemakers
- Sick sinus syndrome (symptomatic bradycardia with frequent sinus pauses)
- Second degree AV Block
- Third degree AV Block
- Tachyarrhythmia - PSVT
Pacemaker complications
Infection - erythema, swelling, purulent discharge
Risk factors - DM, defibrillator placement
Tachyarrhythmia Ddx
- Sinus tachycardia
- SVT (paroxysmal, with aberrancy)
- AF/Flutter
- Torsades de pointes
Most common marfans murmur
Aortic regurgitation
Rheumatic fever Dx
JONES
- Joints - migrating polyarthritis (tends to be large joints)
- Heart - carditis (endocarditis causing rheumatic heart disease, mostly mitral stenosis), may also have pericarditis
- Nodules - subcutaneous nodules on extensor surfaces
- Erythema marginatum - non-itchy red rings on trunk
- Sydenham’s chorea - late finding
Rheumatic fever Ddx (migratory polyarthritis with rash)
- Myocarditis
- Lyme’s disease
- SLE
- Bacterial endocarditis
- Juvenile idiopathic arthritis
Rheumatic fever investigations
- FBC
- ESR and CRP (raised due to inflammation)
- Antistreptolysin O titre + throat culture (test for group A strep)
- ECG - AV Block
- CXR - signs of CHF
- ECHO - check valves, MR,MS,AR
Rheumatic fever management
- NSAIDS - polyarthritis
- Corticosteroids - carditis
- Management of CHF
- prophylactic penicillin
Strepococcal pharyngitis Tx
10 days penicillin
Or 5 days erythromycin
Causes of Central Cyanosis
- Hypoxic Lung Disease
- Right to Left shunt
- cyanotic congenital heart disease
- eisenmenger’s syndrome - Methaemoglobinaemia (drug or toxin-induced)
